STD Code 7. Tel. No.

email ID

Tel. No.

8. Sex (For Individual Applicants only) Please Tick ! as applicable 9. Status of the Applicant Individual P Hindu Undivided Family H Company C Please Tick ! as applicable Firm F Association of Persons A Association of Persons (Trusts) T

Male

Female

Body of Individuals B Local Authority L Artificial Juridical Person J

10. Date of Birth / Incorporation / Agreement / Partnership or Trust Deed / Formation of Body of Individuals / Association of Persons

D D

M M

Y Y

11. Registration Number (In case of Firms, Companies etc.)

12. Whether citizen of India

Please Tick !

as applicable Others

Yes

No

13. (a) Are you a salaried employee? If yes, indicate Government Name of the Organisation where working

(b) If you are engaged in a business / profession, indicate nature of business or profession and fill the relevant code

(c) If you are not covered by (a) or (b) above, indicate sources of income, if any

14. Full name, address of the Representative Assessee, who is assessable under the Income Tax Act in respect of the person, whose particulars have been given in column 1 to 13. Full Name (Full expanded name : initials are not permitted) Please tick ! as applicable Last Name / Surname Middle Name Shri Smt. First Name Kumari M/s

Address Flat/Door/Block No.

Name of Premises / Building / Village

Road / Street / Lane / Post Office Area / Locality / Taluka / Sub - Division Town / City / District State / Union Territory Pin (Indicating PIN is mandatory) 15. I/We have enclosed proof of address. as proof of identity and as

I/We what is stated above is true to the best of my / our information and belief.

, the applicant, do hereby declare that

Verified today, the D D M M Y Y Y Y Signature / Left Thumb Impression of Applicant (inside the box)

V. 1.0

Form No. 49A

Application for Allotment of Permanent Account Number
Under Section 139A of the Income Tax Act, 1961 (To avoid mistake(s), please follow the accompanying instructions and examples carefully before filling up the form)

Form No. ITS 49A

To The Assessing Officer Ward / Circle Range Commissioner Sir,

Area Code

AO Type

Range Code

AO No.

Only Individuals to affix recent photograph (3.5 cm 2.5 cm)

I/We hereby request that a permanent account number be allotted to me/us. I/We give below necessary particulars : 1. Full Name (Full expanded name : initials are not permitted) Please Tick ! as applicable Shri Last Name / Surname Middle Name Smt. Kumari M/s First Name

Signature/Left Thumb Impression

2. Name you would like printed on the card 3. Have you ever been known by any other name ? If yes, please give that other name (Full expanded name : initials are not permitted) Last Name / Surname Middle Name Please Tick ! Shri Smt. as applicable Kumari M/s First Name Yes No

4. Fathers Name (Only Individual applicants : Even married women should give fathers name only) Last Name / Surname Middle Name First Name

5. Address R. Residential Address Flat/Door/Block No.

Name of Premises / Building / Village

Road / Street / Lane / Post Office Area / Locality / Taluka / Sub - Division Town / City / District O. Office Address (Name of Office) Flat/Door/Block No. Name of Premises / Building / Village Road / Street / Lane / Post Office Area / Locality / Taluka / Sub - Division Town / City / District State / Union Territory Pin (Indicating PIN is mandatory) 6. Address for communication Please Tick ! as applicable R or O
V. 1.0

State / Union Territory

Pin (Indicating PIN is mandatory)